Effectiveness and Safety of Originator and Biosimilar G-CSF as Primary Prophylaxis in DLBCL: A Cohort Study and Meta-Analysis

Abstract

Abstract Background Real-world data on the comparative use of originator and biosimilar granulocyte colony-stimulating factors (G-CSF) in Asia is lacking. This study aimed to compare the effectiveness and safety of originator and biosimilar G-CSF as primary prophylaxis in patients with diffuse large B-cell lymphoma (DLBCL).Methods This cohort study evaluated patients with previously untreated DLBCL who received chemotherapy and primary prophylactic G-CSF. We assessed the incidence of febrile neutropenia, severe neutropenia, post-chemotherapy nadir absolute neutrophil count (ANC), infection, and adverse events (AEs) in patients receiving biosimilar G-CSF compared to those receiving originator G-CSF. Inverse probability weighting and logistic/linear regression were used. Additionally, a systematic review and meta-analyses were performed to compare febrile neutropenia incidence.Results We included 146 patients (65 years, 58% female). The majority (92%) received short-acting G-CSF; 35 patients received a biosimilar. There was no significant difference between biosimilar and originator G-CSF in febrile neutropenia (adjusted odds ratio: 0.31, 95% CI: 0.06, 1.61), infection (0.79; 0.23, 2.77) and severe neutropenia (0.21; 0.04, 1.11). Biosimilar G-CSF was associated with increased post-chemotherapy ANC (β: 1176.30, SE: 495.27, p: 0.019). None experienced an AE leading to G-CSF withdrawal or death. The results of the meta-analyses indicated comparable effectiveness between the short-acting biosimilar and the originator (1.03; 0.73, 1.44), but the long-acting originator G-CSF exhibited a superior effect (1.73; 1.24, 2.43).Conclusions Short-acting biosimilar G-CSF was as effective as originator G-CSF in preventing febrile neutropenia, whereas long-acting originator G-CSF may provide better protection. These results informed decision-making and formulary policies.